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WEDNESDAY, July 31, 2013 — The number of type 2 diabetes cases among young Americans is growing at an alarming pace, with 3,700 kids under age 20 diagnosed with diabetes every year, according to the U.S. Centers for Disease Control and Prevention (CDC). Researchers have found the rate of increase to be disproportionately higher for some ethnic and demographic groups. For every new case of diabetes among whites under 21, there are 3 cases among young Hispanics, 4.5 among Pacific Islanders, 5 among blacks, and 8 among American Indians, according to the CDC.

What makes one group more susceptible than others?

Environmental factors such as limited access to health care, poor diet, and smoking are only partly to blame. “The increased reliance on fast food and store-bought food, combined with decreased physical activity, [has led to] increased obesity and diabetes in adults as well as in children,” said Betul Hatiopoglu, MD, an endocrinologist at the Cleveland Clinic, “[but] some of the risk is from non-modifiable factors, such as age, race, and ethnicity.”

“Most of the youth with type 2 diabetes have an affected parent or other family members,” said Lorraine Katz, MD, associate professor of pediatrics at the Children’s Hospital of Philadelphia. “So it’s not surprising when they are diagnosed.”

Past studies have shown that genetic predisposition plays a strong role in development of type 2 diabetes. Researchers from the University of Texas Southwestern, for example, have identified a specific variant of a gene that increases susceptibility to type 2 diabetes in Caucasians and South Asians.

Special Challenges for American Indians

“One contributing factor to the high rate [in American Indians] may be prenatal exposure to diabetes,” said Andrew Norris, MD, PhD, associate professor of pediatrics and biochemistry at the University of Iowa Children’s Hospital in Iowa City. “Because the rate of diabetes during pregnancy is high in this population, this may be a significant contributor to even higher rates of diabetes with each generation.”

In addition, American Indians are probably predisposed by their genes to develop diabetes, said Phil Zeitler, MD, PhD, professor of pediatrics and clinical science at the University of Colorado, Denver.

Although genetics plays a role, it doesn’t explain everything. Lifestyle choices also influence development of type 2 diabetes, with the key lifestyle determinants being diet, physical activity and smoking. Children tend to have habits similar to their parents and other family members, so in this way genetic predisposition can be compounded by lifestyle and personal choices.

“American Indian youth have higher rates of obesity and physical inactivity than whites, which raises their risk of diabetes,” said Neda Laiteerapong, MD, assistant professor of medicine at the University of Chicago. “Additionally, American Indians are more likely to live in food deserts, areas with limited access to affordable and nutritious food, and instead have ready access to fast food."

Across the board, childhood obesity affects 32 percent, or approximately 1 in 3, children between the ages of 2 and 19, according to the latest data by the CDC, and the number is expected to grow. Over the next 18 years, the obesity rate could climb up to 42 percent, according to the CDC, which means millions of kids would be facing not only diabetes, but heart disease as well.

"Urban dwellers are more likely to be sedentary, live in high-stress environments with easy access to calorie-dense foods and have little access to safe places for exercise,” she said.

“A lot of families [of type 2 diabetic children] live in an inner city and don’t have access to supermarkets or fresh produce,” Dr. Katz added. “Or, there is access, but it’s harder and more expensive. Sometimes it’s more convenient to pick up fast food than to cook.”

Children and adults in the South are at particular risk for diabetes – especially if they live in the area known as the “Diabetes Belt,” which stretches from Louisiana to West Virginia. Within this area, 11.7 percent of the population has type 2 diabetes, according to the CDC. Outside of the belt, the rate is 8.5 percent.

”The South has larger populations of minorities with higher rates of diabetes,” said Marcie Drury Brown, MD, an assistant professor of pediatrics at the Center for Diabetes Research at Wake Forest Baptist Health Medical Center in North Carolina. “The South also has more people living in poverty, a risk factor for obesity and type 2 diabetes.”

Southern cooking doesn’t help with the diabetes rate either, said Laiteerapong.

“Many traditional Southern foods are calorie-dense and of low nutritional value, which contributes to the obesity epidemic in the South,” she said.

However, when it comes to figuring out who develops diabetes as a child, it’s ultimately not just genetics or the environment, said Dr. Brown, but a combination of the two.

“Specific ethnic groups may carry a greater number of these high risk genes or may carry specific genes which carry a strong predisposition for diabetes,” she said. “Frequently there is interplay between genes and the environment that a person lives in. The environment may turn these genes that increase risk for diabetes on or off.”

And unless something is done to combat both genetic and environmental risk factors for diabetes in the young, the rate will continue to spiral, Brown said.

“One generation of people with higher risk factors and rates of diabetes gives birth to the next generation,” she said. “That next generation’s risk is even higher if they follow in the footsteps of the previous generation.”

Chika Anekwe, MD, is a third-year preventive medicine resident at SUNY Stony Brook Medical Center and a part-time MPH student at Columbia University. Dr. Anekwe graduated from the University of Connecticut School of Medicine in 2011 and completed a one-year internship in pediatrics at NYU.

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